The effect of number and types of comorbidities on all-cause readmission in Danish patients hospitalised with chronic obstructive pulmonary disease
Authors
Trygvadottir, Svanna Jetta ; Trygvadóttir, Rannvá Eyðleyg
Term
5. Term (Master thesis)
Education
Publication year
2023
Abstract
Background: Comorbidities are common in chronic obstructive pulmonary disease (COPD) and may influence readmission risk. Aim: to assess how the number of comorbidities relates to 30-, 90-, and 365-day all-cause readmissions after a hospitalization for COPD exacerbation, to identify which comorbidity types are associated with increased risk, and to compare the predictive value of number versus type. Methods: Retrospective cohort of all patients admitted with COPD exacerbation in the North Denmark Region in 2018 (n=1,439; age ≥40 years). Cumulative incidence was estimated with Kaplan–Meier, and two adjusted Cox models examined, respectively, the number and types of comorbidities; model performance was compared using ROC curves and AUC. Results: Compared with patients without comorbidity, 90- and 365-day readmissions were higher among those with 2–3 (HR 1.304 and 1.254) and ≥4 comorbidities (HR 1.984 and 2.129). Atrial fibrillation/flutter and interstitial lung disease were associated with increased 30-, 90-, and 365-day readmissions. Anxiety predicted 30- and 365-day readmissions, and asthma and lung cancer were linked to higher 365-day readmissions. The model based on comorbidity count had higher AUCs than the model based on comorbidity types (0.896/0.871/0.875 vs. 0.800/0.840/0.848). Conclusion: Having at least two comorbidities and certain specific conditions increases readmission risk, and the total number of comorbidities is a better predictor of 30-, 90-, and 365-day readmissions than comorbidity type.
Baggrund: Komorbiditeter er hyppige hos patienter med kronisk obstruktiv lungesygdom (KOL) og kan påvirke risikoen for genindlæggelse. Formål: at undersøge sammenhængen mellem antal komorbiditeter og 30-, 90- og 365-dages genindlæggelse efter en hospitalsindlæggelse for KOL-exacerbation, at identificere hvilke komorbiditetstyper der er forbundet med øget risiko, og at sammenligne den prædiktive værdi af antal kontra type. Metoder: Retrospektivt kohortestudie af alle patienter indlagt med KOL-exacerbation i Region Nordjylland i 2018 (n=1.439; ≥40 år). Kumulativ risiko blev estimeret med Kaplan-Meier, og to justerede Cox-modeller undersøgte henholdsvis antal og typer af komorbiditeter; modelpræstation blev sammenlignet med ROC-kurver og AUC. Resultater: Sammenlignet med patienter uden komorbiditet var 90- og 365-dages genindlæggelse højere hos patienter med 2–3 (HR 1,304 og 1,254) og ≥4 komorbiditeter (HR 1,984 og 2,129). Atrieflimren/-flutter og interstitiel lungesygdom var forbundet med øget 30-, 90- og 365-dages genindlæggelse. Angst var relateret til 30- og 365-dages genindlæggelse, og astma samt lungekræft var forbundet med øget 365-dages genindlæggelse. Modellen baseret på antal komorbiditeter havde højere AUC end modellen baseret på typer (0,896/0,871/0,875 vs. 0,800/0,840/0,848). Konklusion: At have mindst to komorbiditeter og visse specifikke tilstande øger risikoen for genindlæggelse, og samlet antal komorbiditeter er en bedre prædiktor for 30-, 90- og 365-dages genindlæggelse end den enkelte type.
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